The Association of Unconventional Natural Gas Development with Adolescent Internalizing Disorders

摘要 自2000年以来，非常规天然气开发(UNGD)随着其 化学、物理和心理社会危害以及更广泛的社区影响。而UNGD则拥有 十多年来一直受到公众的关注，但目前还没有研究评估UNGD和 青少年的心理健康结果，尽管认识到儿童可能是最脆弱的 人口对环境暴露的不利影响。确定与抑郁相关的因素 焦虑是非常重要的，因为这些疾病会导致残疾，降低生活质量，以及 在临床护理和公共卫生方面需要高额支出。先前的研究涉及两条主要途径 从联合国儿童基金会的活动来看，空气质量和压力都会影响儿童的心理健康。我的 因此，假设UNGD活动有助于增加新发病内化的几率 青少年的精神障碍。我们建议使用电子健康记录(EHR)来验证这一假设 宾夕法尼亚州盖辛格卫生系统正在进行一项流行病学研究，研究两者之间的联系 UNGD活动(使用结合了空间和时间的现有指标单独分配给患者 关于UNGD的信息，按井阶段、大小和产气量以及患者的住所)，以及新的发病情况 内在化障碍，使用诊断代码和用药顺序的组合对我们的结果进行分类， 在大约35,000名青少年人口中。对于我的子目标，分析将指向效果 这一联系的修改，特别是按性别、接受医疗援助、处方 抗抑郁剂和居民区绿化。我的第二个目标是审查UNGD的协会 使用患者健康评分在大约28,000名青少年中进行有抑郁症状的活动 问卷调查(PHQ-9)。使用PHQ-9数据将使我们能够评估更广泛的短期 抑郁症状具有更高的敏感度，而诊断和用药顺序将确定更严重的 焦虑、抑郁障碍具有较高的特异性。在次级目标中，我将评估协会是否 当UNGD活动指标仅限于钻井和水力压裂阶段时，加强 (因为报告的卡车流量较高)，以及当将评估的症状限制在 关于睡眠和注意力的问题。拟议的研究将是第一次调查#年联合国国家安全和发展方案的活动。 与青少年心理健康的关系。通过利用广泛分布的地区的大样本量的EHR数据 通过开展联合国全球减贫战略活动，这些研究可以促进对联合国全球减贫战略对健康的潜在影响的了解。 通过全面的培训计划和密切的指导，PI将接受以下主题领域的培训 青少年心理健康，环境流行病学分析方法的使用，以及沟通 将研究成果提供给政策利益攸关方。因此，该项目将有助于国际和平协会的长期目标，即 从事环境流行病学研究，为循证健康政策提供信息。

ABSTRACT Unconventional natural gas development (UNGD) has dramatically expanded since 2000 along with its chemical, physical, and psychosocial hazards as well as more general community impacts. While UNGD has been of public concern for over a decade, no study yet has evaluated the relationship between UNGD and mental health outcomes in adolescents, despite the recognition that children may be the most vulnerable population for the adverse effects of environmental exposures. Identifying factors associated with depression and anxiety is of high importance because these disorders can lead to disability, decrease quality of life, and require high expenditures for clinical care and public health. Prior research implicates two primary pathways from UNGD activity, air quality and stress, both of which can impact the mental health of children. My hypothesis is therefore that UNGD activity is contributing to increased odds of new onset internalizing disorders in adolescents. We propose to test this hypothesis using electronic health records (EHRs) from the Geisinger health system in Pennsylvania, conducting an epidemiologic study of the association between UNGD activity (assigned individually to patients using existing metrics which incorporate spatial and temporal information on UNGD by well phase, size, and gas production, and the patient’s residence), and new onset internalizing disorders, classifying our outcome using combinations of diagnosis codes and medication orders, in an adolescent population of approximately 35,000. For my sub-aims, analysis will be directed toward effect modification of this association, specifically by sex, receipt of Medical Assistance, prescription of antidepressants, and residential greenness. My second aim proposes to examine the association of UNGD activity with depressive symptoms among approximately 28,000 adolescents, using scores from Patient Health Questionnaires (PHQ-9). Using PHQ-9 data will enable us to evaluate a broader range of shorter-term depressive symptoms with higher sensitivity, while diagnoses and medication orders will identify more severe anxiety and depression disorders with higher specificity. In sub-aims, I will assess if the association strengthens when the UNGD activity metric is limited to specifically the drilling and hydraulic fracturing phases (because of higher reported truck traffic) and if it strengthens when limiting the symptoms evaluated to those regarding sleep and concentration. The proposed studies will be the first to investigate UNGD activity in relation to adolescent mental health. By utilizing EHR data with a large sample size in a region with extensive UNGD activity, these studies can advance the state of knowledge on potential health impacts of UNGD. Through a comprehensive training plan and close mentorship, the PI will receive training in the subject area of adolescent mental health, the use of analytic methods for environmental epidemiology, and the communication of research findings to policy stakeholders. Thus, this project will contribute to the PI’s long-term goal of a career in environmental epidemiologic research to inform evidence-based policies for health.